Endocrine Research Laboratory, Endocrine-Diabetes Center, Aurora St. Luke's Medical Center, Milwaukee, WI 53215, USA.
Pituitary. 2012 Mar;15(1):64-70. doi: 10.1007/s11102-011-0333-0.
This short review summarizes the use of late-night salivary cortisol measurement in the diagnosis of Cushing's syndrome, in the evaluation of patients with adrenal incidentalomas, and in monitoring of post-operative patients, with a focus on the different assay methodologies currently in common use. The focus is on recent studies identified by literature searches using Ovid Medline and Google Scholar as well as analysis of several recent review articles on the topic. Measurement of late night salivary cortisol (LNSC) has an excellent sensitivity and specificity for the diagnosis of Cushing's syndrome regardless of the assay methodology used. Immunoassays have the advantage of simplicity, low cost, and small sample volume requirement, while liquid chromatography-tandem mass spectrometry has the advantage of a high specificity for cortisol and the ability to measure cortisone. The overnight dexamethasone suppression test appears to be superior to LNSC measurement in the evaluation of patients with adrenal incidentalomas. LNSC measurement is an excellent approach to monitor post-operative Cushing's disease patients for surgical failure or recurrence. Salivary cortisol is most useful as the initial test when Cushing's syndrome is suspected and for periodic patient monitoring after pituitary surgery for Cushing's disease.
这篇简短的综述总结了深夜唾液皮质醇测量在库欣综合征诊断、肾上腺意外瘤患者评估以及术后患者监测中的应用，重点介绍了目前常用的不同检测方法学。本文的重点是使用 Ovid Medline 和 Google Scholar 进行文献检索以及对该主题的几篇最新综述文章进行分析后确定的近期研究。无论使用何种检测方法学，深夜唾液皮质醇（LNSC）测量对库欣综合征的诊断均具有极好的敏感性和特异性。免疫测定法具有简单、成本低和所需样本量小的优点，而液相色谱-串联质谱法具有皮质醇特异性高和能够测量皮质酮的优点。在评估肾上腺意外瘤患者时， overnight dexamethasone suppression test（ overnight 地塞米松抑制试验）似乎优于 LNSC 测量。LNSC 测量是监测术后库欣病患者手术失败或复发的极好方法。当怀疑库欣综合征时，唾液皮质醇最有用作为初始检查，并且在库欣病经垂体手术后用于定期患者监测。
